The Evolution of Nursing Homes Into Comprehensive Geriatrics Centers: A Perspective

Nursing homes typically have been a relatively isolated component of health care in the United States. Now, however, nursing homes are experiencing a change in the patients they serve. In recent years, nursing home patients have been admitted sicker and after a shorter hospital stay than in the past. Such changes are likely to continue to occur as the size of the population of frail elderly continues to increase and as insurers look for alternatives to high cost hospital care. An additional stimulus to change is that the public is asking for innovation in noninstitutionalized long‐term care. This essay advocates that nursing homes are the ideal component of the health care system to lead innovative program development focused on the creation of a highly organized continuum of care for the frail elderly. Physicians must be a fundamental part of this process, providing the guidance and leadership necessary for nursing homes to evolve into comprehensive geriatrics centers. Strategies are provided for developing physician office practices in nursing homes, a fundamental first step in the process of change. Additionally, ideas are provided for developing day care centers and physician house call programs based in nursing homes. Also, tight and highly functional relationships among nursing homes and acute hospitals must be developed. The example of the Johns Hopkins Geriatrics Center is described briefly as one such program now in place. As nursing homes evolve into comprehensive geriatrics centers and provide a full continuum of health care programs, they will serve the needs of the elderly much more effectively than is now possible. 1994 The American Geriatrics Society